Abstract
Objectives
This presentation will help the physician optimize their management of this rare complication.
Methods
Presentation of a case series from our experience with the management of 3 endonasal surgery complications of intracranial hemorrhage due to anterior cerebral artery trauma. We present a review of the literature and propose an algorithm for the prompt and appropriate management of this complication.
Results
The recognition of actual or potential intracranial vascular injury following trauma to the skull base during endonasal surgery requires prompt identification and management that extends beyond that of simple CSF leak repair. During the immediate post-operative period, identification of the extent of injury with neurovascular imaging studies and early neurosurgical consultation is essential. Intermediate peri-operative management focuses on the prevention of the additional complications of intracranial infection, an intracranial hematoma, and pseudoaneurysm formation by using staged angiography. Long-term management focuses on optimizing a patient's functional outcome with selective use of MRI to evaluate brain healing while assessing the risk for developing a convulsive disorder.
Conclusions
Awareness of the potential for trauma to the anterior cerebral artery complex following skull base penetration during endonasal surgery will allow a surgeon to better anticipate and manage its potential sequelae, thereby reducing the risk of an unfavorable outcome.
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